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The role of dynamic thiol/disulfide homeostasis for the evaluation of oxidative stress in endometriosis patients
No full textObjective: To evaluate the role of oxidative stress in endometriosis patients by determining dynamic thiol/disulfide homeostasis and ischemia modified albumin (IMA) levels. Patients and Methods: This prospective case-controlled study was conducted at a tertiary gynecology clinic in Istanbul, Turkey. 86 patients previously diagnosed with endometriosis and persistent endometriomas were included in the study group. 60 patients who visited the clinic during the study period for routine gynecological control were included in the control group. Thiol/disulfide parameters and IMA levels were determined from the serum samples. Results: When the thiol/disulfide parameters were compared between the study and the control group no significant difference was observed (p=0.49). Mean disulfide level in the control group was 18.58 +/- 5.73 mu mol/L, and in the study group was 18.61 +/- 7.37 mu mol/L. Levels were statistically similar in both groups (p=0.98). In addition, there were no differences between the groups in terms of IMA and albumin levels. Conclusion: The results of this study revealed no significant difference in the dynamic thiol/disulfide homeostasis among the endometriosis patients. Although, it has been accepted as a potential oxidative stress marker in other chronic inflammatory diseases, its use in determining the systemic oxidative stress level in endometriosis patients is limited.2143-1473
Spinal deformity surgery is accompanied by serious complications: report from the Morbidity and Mortality Database of the Scoliosis Research Society from 2013 to 2020
No full textPurpose The Morbidity and Mortality (M\&M) report of the Scoliosis Research Society (SRS) has been collected since 1965 and since 1968 submission of complications has been required of all members. Since 2009, the SRS has collected information on death, blindness, and neurological deficit, with acute infection being added in 2012 and unintentional return to the operating room (OR) being added in 2017. In this report, we use the most recent data submitted to the SRS M\&M database to determine the rate of neurological deficit, blindness, acute infection, unintentional return to the OR, and death, while also comparing this information to previous reports. Methods The SRS M\&M database was queried for all cases from 2013 to 2020. The rates of death, vision loss, neurological deficit, acute infection, and unintentional return to the OR were then calculated and analyzed. The rates were compared to previously published data if available. Differences in complication rates between years were analyzed with Poisson regression with significance set at alpha = 0.05. Results The total number of cases submitted per year varied with a maximum of 49,615 in 2018 and a minimum of 40,464 in 2020. The overall reported complication rate from 2013 to 2020 was 2.86\%. The overall mortality rate ranged from 0.09\% in 2018 to 0.14\% in 2015. The number of patients with visual impairment ranged from 4 to 13 between 2013 and 2015 (no data on visual impairment were collected after 2015). The overall infection rate varied from 0.95 in 2020 to 1.30\% in 2015. When the infection rate was analyzed based on spinal deformity group, the neuromuscular scoliosis group consistently had the highest infection rate ranging from 3.24 to 3.94\%. The overall neurological deficit rate ranged from 0.74 to 0.94\%, with the congenital kyphosis and dysplastic spondylolisthesis groups having the highest rates. The rates of unintentional return to the OR ranged from 1.60 to 1.79\%. Multiple groups showed a statistically significant decreasing trend for infection, return to the operating room, neurologic deficit, and death. Conclusions Neuromuscular scoliosis had the highest infection rate among all spinal deformity groups. Congenital kyphosis and dysplastic spondylolisthesis had the highest rate of neurological deficit postoperatively. This is similar to previously published data. Contrary to previous reports, neuromuscular scoliosis did not have the highest annual death rate. Multiple groups showed a statistically significant decreasing trend in complication rates during the reporting period, with only mortality in degenerative spondylolisthesis significantly trending upwards.6NOV1307-13131
Mid-term implant survival, functional and radiological results and mechanical complications of mega-prosthetic reconstruction around the knee with the PENTA (R) system
No full textAim Mega-prosthetic reconstruction is the most common treatment method for massive osteoarticular defects caused by tumor resection around the knee. The new implant is a highly modular rotational-hinged megaprosthesis system with a distinct pentagonal stem geometry and variable implantation options. The aim of this study is to present the mid-term implant survival characteristics, functional and radiological results and mechanical complication profile of the new megaprosthesis. Methods One hundred and one mega-prosthetic knee reconstruction procedures in 90 patients (M/F: 51/39) utilizing the new implant system were retrospectively analyzed. In 68 patients, the megaprosthesis was used for primary reconstruction following tumor resection while it was used for revision of other implants in 22. The mean age was 28.5 (7-66) years and the mean follow-up was 59.2 (24-124) months. The most common primary pathology was osteosarcoma with 63-70\% patients, the most common anatomical site of involvement was the distal femur with 56-62\% patients. Results Henderson Type 2 failure (aseptic loosening) was seen in only 2-2.2\% patients while Type 3 (structural failure) was seen in 29-32.2\% Although the 5-year anchorage survival rate was 94.3\%, overall mechanical implant survival was 76.1\% at 5 years due to a relatively high failure rate in the first-generation hinge mechanism of the implant. The 5-year hinge survival rate demonstrated a significant improvement rate from 61.7\% to 87.2\% between the first and second generations of the implant (p = 0.027). The mean MSTS score was 24 out of 30 (14-29). The mean cumulative ISOLS radiographic score for index megaprosthesis operations was 19.7 (12-24), which corresponded to excellent outcome. Conclusion The new megaprosthesis system is a reliable choice for the reconstruction of tumor-related massive osteoarticular defects around the knee. Although long-term follow-up is necessary for a definitive evaluation of the implant's survival characteristics, midterm follow-up yields exceptional anchorage properties related to pentagonal stem geometry with very good functional outcomes.9SEP2323-233314
The effect of migraine and motion sickness on symptoms evoked by the caloric vestibular test
No full textBACKGROUND: The caloric vestibular test (CVT) may evoke headache and vestibular symptoms in susceptible people. Patients with migraines have higher susceptibility to motion sickness. In migraines, impaired habituation to repetitive stimuli is a well-known interictal abnormality. OBJECTIVE: This study is aimed at evaluating CVT-evoked headache, nausea, vomiting, and imbalance in patients with and without migraine and/or motion sickness. METHODS: A retrospective data analysis was performed on 554 patients with a complaint of dizziness who underwent bithermal CVT at a tertiary referral center. The occurrences of CVT-evoked headache, nausea, vomiting, and imbalance were observed in four groups: patients with only migraine (MGn = 94), those with only motion sickness (MSGn = 89), those with migraine and motion sickness (MMSGn = 122), and those without migraine and motion sickness (non-MMSGn = 146). The differences between the groups were assessed. RESULTS: The mean ages of groups were similar (p = 0.534). The proportions of females were higher in the MG, MSG, and MMSG (p = 0.001). The severity of nausea and headache for each gender was higher in the MG, MSG, and MMSG (p < 0.001). Vomiting was more common in MMSG among males (p = 0.003), while there was no difference between groups among females (p = 0.099). Imbalance was more common in MMSG among females (p < 0.001). A relationship was detected between age and imbalance (p < 0.001), where an increased risk for imbalance was evident with greater age. Three patients in the MMSG needed hospitalization after CVT. CONCLUSIONS: Special caution is needed when performing caloric testing for patients with migraines or MS since CVTevoked symptoms may occur with higher incidence and intensity, which might be related to a lack of habituation in neuronal information processing after robust sensory stimuli like CVT.2135-1443
Performance of the Bethesda System for Reporting Thyroid Cytology in Multi-Institutional Large Cohort of Pediatric Thyroid Nodules: A Detailed Analysis
No full textBackground: To evaluate the performance of TBSRTC through multi-institutional experience in the paediatric population and questioning the management recommendation of ATA Guidelines Task Force on Paediatric Thyroid CancerMethods: A retrospective search was conducted in 4 institutions to identify consecutive thyroid FNAC cases in paediatric population between 2000 and 2018. Following the 2nd TBSRTC, the risk of malignancy ratios (ROMs) was given in ranges and calculated by 2 different ways. Sensitivity, specificity, PPV, NPV and DA ratios were calculated using histologic diagnosis as the gold standardResults: Among a total of 405 specimens, the distribution of cases for each category was, 44 (11\%) for ND, 204 (50\%) for B category, 40 (10\%) for AUS/FLUS, 36 (9\%) for FN/SFN, 24 (6\%) for SFM and 57 (14\%) for M categories. 153 cases have a histological diagnosis. The ratio of surgery was 23\% in ND, 16\% in the B, 45\% for AUS/FLUS, 75\% for SFN/FN and 92\% for SFM and 75\% in M categoriesConclusions: The data underlines the high ROM values in paediatric population which might be clinically meaningful. The high rate of malignancy of the cohort of operated patients (50\%) also underlines the need of better preoperative indicators for stratification. Considering that more than half of the nodules in AUS/FLUS category were benign, direct surgery recommendation could be questionable as proposed in ATA 2015 guidelines.1JAN1
`Stepchildren of the Ministry': an examination of the difficulties endured by family physicians in Istanbul during tie course of the COVID-19 pandemic
No full textIntroduction. Efforts to contain the SARS-CoV-2 virus would fall short without strong primary health care. Aim. In this study, we aimed to understand family physicians' experiences of coronavirus disease 2019 (COVID-19) in Istanbul, focusing on their coping strategies in order to draw lessons for the future management of pandemics. Methods. Twelve community-based physicians working in Istanbul participated in semi-structured interviews between January and May 2021. Purposive sampling was used to ensure a range of physicians' characteristics. Individual interviews were conducted with each participant on an online platform. Participants were asked 26 open-ended questions. Phenomenological analysis was performed to describe experiences of physicians. Results. The physical conditions of participants' health centres were insufficient to provide service safely during the COVID-19 pandemic. Most physicians were uncomfortable about the quality and quantity of personal protective equipment received from the Ministry of Health and took additional measures themselves. Vaccine supply was thought to be insufficient and there were problems with the associated software. Many family physicians highlighted the inadequate communication from the Ministry. Insufficient knowledge about the disease caused anxiety and fear for the physicians and hindered their performance at the beginning of the pandemic. Physicians who live with their families were more anxious than those who did not. Discussion. Despite challenges, routine procedures have mostly been continued, but newly added responsibilities during the COVID-19 pandemic have had significant impact on physicians' lives.157-631
The Mediating Roles of Anxiety, Depression, Sleepiness, Insomnia, and Sleep Quality in the Association between Problematic Social Media Use and Quality of Life among Patients with Cancer
No full textThe present study examined the mediating role of anxiety, depression, sleepiness, insomnia, and sleep quality in the association between problematic social media use and quality of life (QoL) among patients with cancer. This cross-sectional survey study recruited 288 patients with cancer to respond to measures on anxiety, depression, sleepiness, insomnia, sleep quality, problematic social media use, and QoL. Structural Equation Modeling was used for the mediation analysis. There were significant relationships between all of the variables used in the study. It was revealed that problematic social media use did not directly influence the QoL of patients with cancer except via anxiety, depression, sleepiness, and insomnia. Sleep quality did not mediate the association between problematic social media use and QoL. Healthcare workers managing cancer should pay attention to the mental health needs of their patients even as they treat their cancer so as to improve their quality of life. Future studies may examine other variables that affect the QoL of patients with cancer as well as other mediating and moderating variables.9SEP1
Access to Radiation Therapy by Syrian Refugees Displaced to Turkey
No full textFor over 10 years, the Syrian conflict has caused millions of people to leave their homeland, causing one of the biggest refugee crises in modern history. Considering its prevalence, cancer is an important care burden among Syrian refugees. Radiation therapy is one of the essential parts of cancer treatment, and radiation oncology departments must guarantee optimal cancer treatments even in such a challenging setting when patients are displaced forcefully from their homes. National and institutional measures are highlighted in this manuscript to provide suggestions for the delivery of care during refugee crises. There are two issues creating barriers to serving refugee populations: the loss of access to their original care records in Syria for those with a previous diagnosis of cancer referred for continuation of radiation therapy or reirradiation, and the effect of acute radiation therapy toxicity on treatment compliance. (c) 2022 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).4JUL-AUG
An Evaluation of Chronic Hepatitis C Patients' Responses to Direct-Acting Antivirals According to Transient Elastography and Serum Biomarkers
No full textObjectives: In this study, it was evaluated the changes in liver stiffness measurements measured by AST to Platelet Ratio index (APRI), Fibrosis 4 index (FIB-4), Age Platelet index (API), AST-ALT ratio (AAR) and transient elastography (TE) among the non-invasive fibrosis scores in chronic hepatitis C (CHC) patients treated with direct-acting agents (DM) and the effect of treatment. Materials and Methods: Ombitasvir-paritaprevir-ritonavir-dasabuvir +/- ribavirin (RBV) or sofosbuvir +/- ledipasvir (SOF +/- LDV) +/- RBV was given to the patients. Fibrosis scores were calculated with the biochemical data of the patients before the treatment, at the 4s . week of the treatment, at the end of treatment and at the sustained virological response 12 (SVR12) Liver stiffness measurements were recorded before treatment with TE and in SVR12. Post-treatment SVR12 responses were evaluated. Results: SVR12 was achieved in 97.9\% of 95 patients included in the study. Significant regression was found in APRI and FIB-4 scores, which are among the 4 serum fibrosis markers calculated in all patients (p<0.001, p<0.001). Liver stiffness was measured using TE in 75 patients. It was determined that the liver stiffness measurement (9.3 +/- 6.5 kPa) in SVR12 significantly decreased compared to the baseline (11.6 +/- 7.8 kPa) (p<0.001). Conclusion: DAA provides improvement in fibrosis scores and persistent viral response in patients. In our study, in which fibrosis was evaluated non-invasive methods, it was observed that there was a significant improvement in liver fibrosis with APRI, FIB-4 and TE measurements.1APR18-242